Please take a moment to fill this form.

2) If you have been with NewLife Fertility for more than one month/cycle, what stage of your management are you at?
Diagnosis Undergoing Treatment Completed Treatment ( look in the drop box, please add all the words)

3) Did you receive enough information about your treatment?

If No, please comment.

4) Did you have a chance to discuss your treatment options, risks benefits and alternatives?
With your DOCTOR?

With your NURSE?

If No, please comment.

5) Did you feel that your infertility diagnosis was clear and that your management
plan addressed your diagnosis?

6) Did you find the staff at the clinic accessible (available)?

If No, please comment.

7) Did you find the staff supportive and compassionate during your treatment?

If No, please comment.

8) Would you recommend us to others?

If No, please comment.

9) Based on your experience visiting our clinic, how would you rate the following?

If you rated anything in the poor, fair or satisfactory rating, please explain your concerns:


Other Suggestions and/or comments

We will use this information to assess and improve our current practices. Your feedback is appreciated.
Information submitted will be kept private and confidential. Thank you.
OPTIONAL:

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